Use of dexemedetomidine beyond 24 hours in the intensive care unit

Introduction

Adequate sedation of critically ill patients is essential to ensure maximal quality of care in the high-stress environment of the intensive care unit (ICU). The main goals of sedation include augmentation of pain control, management of agitation and psychological distress, and improvement of patient tolerance and acceptance of the endotracheal tube and ventilatory support.

Dexemedetomidine (DEX) is a potent α₂-adrenoceptor agonist with an α₂:α₁ ratio of 1300:1 that produces stable tranquility with rousability. DEX permits haemodynamic stability by effectively blunting both cathecolamine and haemodynamic responses to endotracheal intubations, surgical stress, and arousal from anaesthesia.

Materials and methods

A retrospective analysis of the data of 107 patients (54 surgical, 50 clinical and three trauma) admitted to a 27-bed general ICU from October 2000 to October 2002 was performed.

We evaluated DEX indication, time of usage and dosage, necessity of other sedating drugs, and reasons for DEX interruption.

Results

The patient age average was 62.6 years and the Acute Physiology and Chronic Health Evaluation II score was 12.73. Indications for DEX were sedation for collaboration for weaning from mechanical ventilation, sedation of agitation in the ICU, adjuvant treatment of delirium and adjuvant to analgesia. The average dose used was 0.31 μg/kg per hour (0.17–1.0), and the loading dose was used in only four patients (3.73%). The reasons for interruption of DEX were: arterial hypotension, eight cases (7.47%); sinus bradycardia, three cases (2.80%); bradycardia + hypotension, two cases (1.86%); and weaning failure, 22 cases (20.5%). All cardiovascular events disappeared immediately after DEX interruption. The mean time of usage was 3.25 days (range 1–13 days). Concomitantly sedating drugs had to be used in 25 patients (23.3%): fentanyl in seven (6.54%), haloperidol in seven (6.54%), haloperidol + prometazine in four (3.73%), midazolam in five (4.67%), and midazolam + fentanyl in one (0.93%).

Conclusions

The use of DEX beyond 24 hours appears to be safe and effective for the sedation of ICU patients. The need for other sedating/analgesic drugs occurred in less than one-quarter of the patients and was well tolerated, with no extrapyramidal signs seen with antipsychotic drugs or no respiratory depression with opiates.